The Effect of Continuous Management of Suction Cuff Pressure and Subglottic Irrigation Suction on Preventing VALRI Study

Inclusion Criteria: 1. Age ≥ 18 years; 2. Undergoing endotracheal intubation or tracheostomy; 3. Expected duration of mechanical ventilation exceeding 72 hours; 4. Presence of one or more high-risk factors for reflux/aspiration: recurrent laryngeal nerve injury, cerebral infarction/cerebral hemorrhage (new or pre-existing swallowing dysfunction), cranial surgery/traumatic brain injury (TBI), neuromuscular junction disorders (e.g., myasthenia gravis, muscular dystrophy, Parkinson's disease, or other conditions that weaken swallowing muscle strength and coordination), continuous use of muscle relaxants for ≥ 48 hours during mechanical ventilation, ICU-acquired myopathy, ICU-acquired weakness, gastroparesis (gastric residual volume \> 500 mL/6 hours), or impaired consciousness; 5. Voluntary participation in the study by the subject or their legal representative, with signed informed consent. Exclusion Criteria: 1. Expected duration of mechanical ventilation less than 48 hours; 2. Pregnant or breastfeeding women; 3. Patients with tracheoesophageal or bronchopleural fistula; 4. Difficult intubation (more than three attempts) or patients with reflux/aspiration during intubation (with lung injury and secondary pulmonary infection); 5. Patients with irreversible disease, end-stage conditions, or those expected to die in the near future; 6. Patients already diagnosed with ventilator-associated pneumonia (VAP), i.e., excluding hospital-acquired pneumonia; 7. Patients participating in other clinical trials that are expected to influence the results of this study; 8. Patients deemed unsuitable for inclusion in the study by the investigator.